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Inhaled Pentamidine for Bolivian Mucosal Leishmaniasis
Jaime Soto1,2, Patricia Gutiérrez1,2, Paula Soto1
1Fundación Nacional de Dermatología, Santa Cruz, Bolivia.
Abstract:
Aerosolized pentamidine is Food and Drug Administration approved to treat Pneumocystis pneumonia via a route that does not lead to systemic absorption or toxicity. Because Leishmania is also susceptible to pentamidine and mucosal leishmaniasis is also an infection of the respiratory tract, we performed a pilot study of aerosolized pentamidine (300 mg for 10 days over approximately 4 weeks) for mucosal leishmaniasis caused by Bolivian Leishmania braziliensis with a 2-year follow-up. Of 15 patients, 6 of 7 patients with initially mild disease were cured, 3 of 4 patients with initially moderate disease relapsed at the 18- to 24-month follow-up visits, and 3 of 4 patients with initially severe disease failed early after treatment. This study suggests that inhaled pentamidine may be useful as a well-tolerated treatment of mild mucosal leishmaniasis and that to rule out relapse, mucosal leishmaniasis follow-up should extend to 2 years.
Insights
Inhaled pentamidine shows promise for treating mild mucosal leishmaniasis, offering a well-tolerated option. However, patients with moderate to severe disease experienced relapses, necessitating extended follow-up to detect recurrences.
Area of Science:
- Infectious Diseases
- Pharmacology
- Tropical Medicine
Background:
- Aerosolized pentamidine is FDA-approved for Pneumocystis pneumonia, with no systemic absorption or toxicity.
- Mucosal leishmaniasis, an infection of the respiratory tract, is caused by Leishmania parasites.
- Leishmania parasites are known to be susceptible to pentamidine.
Purpose of the Study:
- To evaluate the efficacy and safety of aerosolized pentamidine for treating mucosal leishmaniasis.
- To assess the treatment outcomes in patients with varying disease severities.
- To determine the optimal follow-up duration for mucosal leishmaniasis patients treated with aerosolized pentamidine.
Main Methods:
- A pilot study involving 15 patients with mucosal leishmaniasis caused by Bolivian Leishmania braziliensis.
- Patients received aerosolized pentamidine (300 mg daily for 10 days over approximately 4 weeks).
- A 2-year follow-up period was implemented to monitor treatment outcomes and detect relapses.
Main Results:
- Six of seven patients with mild disease achieved a cure.
- Three of four patients with moderate disease relapsed between 18 and 24 months.
- Three of four patients with severe disease experienced early treatment failure.
Conclusions:
- Inhaled pentamidine appears to be a well-tolerated treatment for mild mucosal leishmaniasis.
- Relapse is a concern for patients with moderate to severe mucosal leishmaniasis.
- A 2-year follow-up is recommended for mucosal leishmaniasis to effectively rule out relapse.
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